Bilateral evacuation of bilateral non-acute subdural hematomas - evaluation of postoperative outcomes and complications.

INTRODUCTION: Bilateral finding of non-acute subdural hematomas (NASH) is less common compared to unilateral occurrence. The aim of this study was to evaluate results of surgical treatment of bilaterally treated bilateral NASH. METHODS: Retrospective analysis of patients, who underwent bilateral surgical evacuation of NASH (2014-2020). This study was conducted to determine the association between the incidence of postoperative complications and outcome, hematoma recurrence and selected risk factors (including volumetric parameters). Correlations between variables were assessed by using Spearman's correlation. Chi-squared test, Student's t-test (unpaired and paired) and one-way ANOVA were used for univariate analysis. RESULTS: Our study included 29 patients with bilateral NASH who underwent bilateral surgical hematoma evacuation. The laminar hematoma type was associated with higher hematoma recurrence rate (p=0.032) and worse clinical outcome (p=0.043). Larger PHV was significantly associated with larger PV after surgery and worse neurological outcome. Larger PHV, PHCV and PV were significantly associated with higher incidence of NASH recurrence (p=0.0008, p=0.0007 and p=0.00006). CONCLUSION: The laminar hematoma type and larger PHV were significant risk factors for the recurrence of bilateral NASH and worse neurological outcome. Larger PHCV and PV were significantly associated with hematoma recurrence (Tab. 7, Fig. 3, Ref. 24).

Is obesity a significant risk factor of symptomatic spinal epidural hematoma after elective degenerative lumbar spine surgery?

INTRODUCTION: The occurrence of symptomatic spinal epidural hematoma after spine surgery is a rare, but serious major complication whose incidence usually requires urgent surgical intervention. Obesity is currently considered to be one of the most common metabolic diseases. METHODS: Prospective analysis of patients who underwent surgical treatment of degenerative lumbar spine disease from January 2016 to February 2018 with one-year follow-up. All patients underwent decompression of spinal cord and nerve roots. This study was conducted to determine an association between the incidence of spinal epidural hematoma (SEDH) requiring surgical treatment and obesity/body mass index (BMI). RESULTS: In our study, data from 371 patients were assessed. SEDH requiring surgical intervention occurred totally in seven patients (1.89 %). An average BMI in patients with presence of SEDH was 30.67 kg/m2. Our work showed a statistically significant difference between BMI in patients with SEDH compared to patients without SEDH (p = 0.0044). This study also showed a significant difference in incidence of symptomatic SEDH in obese patients compared to non-obese patients (p=0.0158). CONCLUSION: In our study, we found out that obesity is a significant risk factor for the incidence of postoperative SEDH after degenerative lumbar spine surgery (Tab. 1, Fig. 2, Ref. 18).

Analysis of clinical efficiency and early postoperative complications after cranioplasty.

INTRODUCTION: Despite of being considered a routine procedure, cranioplasty is associated with a substantial risk of failure, or postoperative complications. PATIENTS AND METHODS: Postoperative clinical course and rate of complications was assessed in patients undergoing cranioplasty during years 2015-2019 in a retrospective fashion. RESULTS: The most frequent condition requiring cranioplasty was a presence of bone defect after a decompressive craniectomy for traumatic brain injury (45 patients). Revision was needed in 9 cases (12.68 %), removal of the bone flap was necessary in 5 patients (7.04 %). The most common complication observed was an unintended intraoperative durotomy, occurring in 9 patients (12.68 %), which was, however, not associated with an increased risk of reoperation. Postoperative improvement of motor functions was observed in 7 patients (9.86 %). Improvement of consciousness occurred in 8 patients (11.27 %). Early cranioplasty was associated with significantly higher odds for surgical revision, patients after previous craniectomy for traumatic brain injury had significantly increased odds for the overall occurrence of complications. CONCLUSIONS: After a cranial reconstruction, complications with a various degree of severity may occur and even the result in need of the implant removal. Postoperative improvement of focal neuro-deficit is possible as well as improvement on the level of patient's consciousness (Tab. 2, Fig. 2, Ref. 61).

Unintended durotomy during degenerative lumbar spine surgery in patients aged 60 years and older - incidence and risk factors.

ntroduction: Unintended perioperative dural tear is a common complication in spine surgery. Methods: Retrospective analysis of patients over 60 years of age who underwent surgery for degenerative disease of the lumbar spine at the Department of Neurosurgery (University Hospital in Martin) from January 2016 to December 2017. Incidence of incidental perioperative durotomy was analyzed. We analyzed selected risk factors gender, ASA (American Society of Anesthesiologists), surgical diagnosis, type of surgical performance, range of surgical procedure, revision surgery and comorbidities. The results were statistically evaluated using descriptive statistics and Fisher›s test. Results with p.

A review of possible complications in patients after decompressive craniectomy.

Through the decades of its use in the management of neurosurgical emergencies decompressive craniectomy has found its place as a life-saving procedure capable of a radical reduction of the intracranial pressure. Clinical results and rate of survival after decompressive craniectomy vary according to the primary diagnosis, and they have been a subject of multicentric randomized trials. However,  considerable attention also needs to be kept on complications associated with the craniectomy. They are based not only on the procedures invasivity but also on the pathophysiological changes associated with a conversion of the closed intracranial space to an open one. The complications may further disturb the postoperative care and convalescence in the surviving patients, and therefore in the salvageable patients the indication of decompressive craniectomy should be based on information about the expected outcome and complications rate, at the same moment prevention, early recognition and adequate therapy of the complications should be emphasized. This work describes the most common complications occurring in patients after decompressive craniectomy, their pathophysiological principles and means of treatment and prevention.

Is there an impact of subdural drainage duration and the number of burr holes on the recurrence rate of unilateral chronic subdural haematoma?

INTRODUCTION: Purpose of the study is to evaluate a possible influence of subdural drainage duration and burr hole quantity on a relapse of a unilateral chronic subdural haematoma (CHSH). METHODS: Sixty - five patients who underwent evacuation of unilateral CHSH via 1 or 2 burr holes and subdural drainage during a period from January 2014 to December 2018 were retrospectively analyzed. Duration of the subdural drainage and the number of burr holes used were assessed in relation to an incidence of CHSH recurrence. According to the subdural drainage duration, we divided the patient cohort into two subgroups: with the subdural drainage duration of 1-3 days and 4-5 days. We also evaluated a possible influence of the subdural drainage duration on risk of postoperative infection. RESULTS: An overall incidence of CHSH recurrence was 18.5%. In 45 patients treated by means of a single burr hole the haematoma recurrence was observed in 10 patients (22.2%), in 22 patients with two burr holes recurrence occurred in 2 of them (9.1%). The difference was however, not statistically significant (p=0.3214). We did not observe any significant influence of age, gender and subdural drainage duration on the incidence of CHSH recurrence. The duration of subdural drainage had not significant impact on postoperative infection rate (p=0.0950). CONCLUSION: The number of burr holes used does not affect the rate of unilateral CHSH recurrence. Similarly the duration of subdural drainage affects neither the unilateral CHSH recurrence rate nor the incidence of postoperative infection.

Subsidence of anchored cage after anterior cervical discectomy.

PURPOSE: Cage subsidence (CS) represents a risk factor for adjacent segment degeneration (ASD) and unfavorable results of anterior cervical discectomy (ACD). METHODS: Sixty-one patients after level 1 or 2 of ACD with implantation of Zero Profile VA cage were included in the study. CS was assessed with a follow-up period of 12 months after ACD. The impacts of factors such as sex, age, number of operated segments, osteoporosis and extent of peroperative distraction were assessed in relation to the incidence of CS. The influences of CS on clinical results (VAS, NDI, Odom's criteria) and ASD incidence were evaluated. RESULTS: In 74 % of cases there was the presence of CS into both adjacent vertebral bodies. CS into the ventral part of motion segment was dominant during the entire follow-up period. CS had no influence on clinical results of ACD. Parallel CS into both ventral and dorsal parts of motion segments significantly increased the incidence of proximal ASD (p = 0.0163). Osteoporosis and extent of peroperative distraction were linked to higher incidence of CS into the dorsal part of motion segment (p ˂ 0.05). CONCLUSIONS: Osteoporosis and the extent of peroperative distraction are risk factors for the subsidence of anchored cage and while increasing the incidence of proximal adjacent segment degeneration it has no significant influence on clinical results of surgery (Tab. 3, Fig. 5, Ref. 32).

Dysphagia after anterior cervical discectomy and interbody fusion - prospective study with 1-year follow-up.

INTRODUCTION: Dysphagia is a common finding after anterior cervical discectomy. The incidence and severity of swallowing disorders are variable and depend on many factors. METHODS: 73 patients after 1- or 2-level anterior cervical discectomy and fusion /ACDF/ were enrolled in prospective, single-center study. The severity of dysphagia was evaluated by the Bazaz-Yoo dysphagia score before surgery and 6 weeks, 3, 6 and 12 months after surgery. The impact of factors such as sex, age, number of operated segments, smoking, gastroesophageal reflux disease, hypertension, duration of surgery and pre-existing dysphagia on the incidence of dysphagia after surgery was verified. The correlation between the duration of surgery and severity of postoperative dysphagia, and similarly between the age and severity of preoperative and postoperative dysphagia was studied. RESULTS: Dysphagia was present in 22% patients within 12 months after surgery. No patient reported severe dysphagia. No significant relationship was demonstrated between sex, age, number of operated segments, pre-existing dysphagia, gastroesophageal reflux disease, hypertension and the incidence of dysphagia after surgery. Smokers showed a significantly lower incidence of dysphagia before surgery and within 12 months after ACDF (p.

Surgical site infections after degenerative lumbar spine surgery.

Degenerative lumbar spine disease is nowadays considered as a serious health condition, because the number of patients requiring a surgical intervention is in last decades rapidly increasing. At the time of surgery indication, it is important to assess the risk of complications incidence, especially surgical ones, because when they occur, they usually lead to reoperation, prolonged hospitalisation and drug use, economic consequences and a compromised postoperative outcome and benefits. Postoperative infectious complications may occur, even after following aseptic and hygienic epidemiological rules. This article contains an interdisciplinary review of diagnosis, treatment and prevention of postoperative surgical site infections after degenerative lumbar spine surgery. Key words: postoperative complications lumbar spine surgical treatmens - spondylodiscitis.